David M. Shribman: The country looks back to go forward

Three critical debates are driving us to reconsider health care, poverty and economic inequality

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In almost every period of our history the national focus has been on the future. The debate about slavery was about the preservation or the abolition of the peculiar institution, not about its origins. The debate about civil rights was about the prerogatives of blacks in a changing nation, not about the roots of prejudice. The debate about Vietnam was about whether the country’s fall to Communism would trigger the fall of other Asian dominos, not about America’s legacy of involvement in the East.

Which is why this is such an extraordinary moment in our national life. For the country in recent weeks has been engaged in three unusual debates, focused not on a misty future but on a cloudy past, designed not to shape the years to come but to understand years gone by. This is a distinctly un-American impulse, and yet this is a peculiarly American passage, a pause to examine our most fateful pathways and to evaluate our most cherished mythologies.

This is a moment that comes as the affirmative-action doctrine that has governed admission to the nation’s most selective colleges and professional schools is being rethought, as the nation’s response to the fall of the Soviet bloc is being reassessed, and as the presidencies of both Presidents Bush are being reappraised.

But standing out amid all these re-evaluations are three other, critical undertakings in reanalysis, serious reassessments that are not mere academic exercises but are instead vital examinations that will, even as they look back, guide Americans as they move forward. Here are the old questions, full of new implications, that are being asked by policy makers and voters alike:

• How did we get into this irrational situation with medical care, where health insurance is tied to employment?

No one designing a health-care system for a post-industrial nation of enormous wealth and with some of the most advanced medical facilities in the world would tie the health of its citizens to the employment of its citizens. And in fact, no one did. It just developed that way, the result of efforts to improve the quality of life of workers’ families without providing wage hikes and without exposing their improved circumstances to increases in their tax bills.

It was, for a time, a great boon, especially to unionized workers in the manufacturing sector, and also to hospitals and physicians, but in time it warped the job market and distorted the medical world, which increasingly became dependent on insurance reimbursements rather than direct patient fees.

This situation led to a generations-long cry for national health insurance, which in turn has reopened the question of tying medical care to employment. Now, under Obamacare, many businesses are evaluating whether they ought to offer health insurance at all, instead considering whether they ought to provide a stipend for their workers to purchase their own plans in the new exchanges — perhaps offering more choice, an important value on the right (which argues for choice in schools) and on the left (which argues for choice in abortion).

• Did the War on Poverty really help reduce poverty?

This is one of those debates whose answers lie in the lies statistics tell. If the debaters sit on the right, they argue that the Johnson-era anti-poverty programs created a culture of dependency, undermining the dignity and family structures of the poor. If they sit on the left, they argue the programs ameliorated poverty and limited its spread. Defying stereotypes exactly 40 years ago, Gary Hart, a Democrat then running for the Senate for the first time, said the War on Poverty raised “the expectations, but not the living conditions, of the poor.”

Spending on programs employing an income test — providing proportionately more to the poor than to others — now represent about one out of every six dollars of federal expenditures. Those on the right argue that official statistics indicate that the number of poor has increased or at best remained constant since 1964, despite billions of dollars of spending. But Bruce Meyer of the University of Chicago and James Sullivan of Notre Dame argue that poverty has fallen by12.5 percent.

This is more than a debate for scholars and ideologues; its answer will give shape to future budgets. House Budget Committee chairman Paul Ryan argues that 92 anti-poverty programs costing about $800 billion offer the poor an incentive not to increase their income. A half-century later, the disagreements continue.

• Was Bill Clinton an effective economic steward?

On the surface, this seems like a pointless debate, Mr. Clinton being a former president more than a dozen years out of office. But it may not be pointless, and not because his wife, former Secretary of State Hillary Rodham Clinton, is contemplating a presidential campaign of her own. (It may be convenient to expect that Mrs. Clinton’s economic policies will mirror those of her husband’s, but the world of 2017 will bear little resemblance to the world of 1993. Ms. Clinton’s outlook may bear little resemblance to Mr. Clinton’s.)

This month Mr. Clinton embarked on an effort to polish his economic record, his argument based on his claim that 7.7 million emerged from poverty during his administration — 100 times as many, he suggested, as during the Reagan years.

Historians have long debated how to parcel out credit and blame for economic booms and declines — a debate of particular interest to Mr. Clinton, who may have been elected because of economic distress during the George H.W. Bush administration and who may have profited, at least in the beginning, from a recovery that gathered force at the end of the Bush administration but took form after Mr. Clinton was inaugurated. The mere act of typing that sentence will, of course, spawn a long and bitter debate, with pugilists taking positions that are completely predictable and also completely self-serving.

That debate will never be concluded to anyone’s satisfaction, but the reason why the debate began in the first place is of vital importance. It underlines the significance — in the Clinton years, at the end of the Obama years and at the beginning of the 45th presidency — of the issue of inequality. By the time the 2016 campaign begins, Sen. Elizabeth Warren of Massachusetts and French economist Thomas Piketty, both of whose books are spawning vigorous debates this spring, won’t be the only ones talking about inequality.

David M. Shribman is executive editor of the Post-Gazette (dshribman@post-gazette.com, 412-263-1890).

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